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  1. 1. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt Focus CKD occurs in people of all ages and both genders. The following factors increase an individualʼs risk for CKD: Chronic Kidney Disease: A Silent Threat • Diabetes, either type 1 or type 2 Chronic kidney disease (CKD), which decreases the kidneyʼs ability to perform its vital functions of • High blood pressure removing impurities from the blood and regulating • Inherited genes for certain disorders such as blood pressure, presents a major, though largely polycystic kidney disease unrecognized, health threat to Americans. Should • Having a relative who has kidney disease damage reach the point that kidney function becomes insufficient to support life, kidney failure, also known • Injury caused by a direct blow to the kidneys as end-stage renal disease (ESRD), occurs. Death is then certain unless dialysis, a mechanical cleansing Diabetes and high blood pressure together account for of the blood, replaces natural kidney function or 70 percent of CKD cases. the person receives a kidney transplant. CKD also increases the risk of cardiovascular disease. Timely As CKD advances, it can produce symptoms such as treatment, however, can greatly slow the progression fatigue, itching, swelling or numbness of the hands of CKD and delay or prevent the onset of ESRD. or feet, nausea, vomiting, cramps, and difficulty concentrating. The progression of CKD to ESRD In its early stages, CKD has no symptoms, and many causes significant burdens. Patients with ESRD face affected people do not realize they have kidney frequent dialysis or surgery for a kidney transplant. disease. The total number of affected people therefore Dialysis recipients must devote several days a week to cannot be known, but estimates are as high as 20 their treatment, and only a small minority can work. A million in the United States. An estimated 8 million transplant requires finding a donor, undergoing major people or more have moderate or severe CKD, surgery, and taking medications over the long term. In approximately 5.9 million of whom are age 65 and 2001, care of persons with ESRD cost Medicare and older. But only about 3 million persons have been other healthcare plans a total of $22.8 billion. diagnosed. CKD affects some population groups much more The majority of the people who develop ESRD first severely than others, with African Americans facing have CKD, which is often undetected for years before almost four times the risk of kidney failure as whites. their kidneys fail. Just under 100,000 persons began For African Americans with diabetes, the risk rises ESRD treatment in the United States in 2001. In all, to six times that of whites. The greatest disparity 400,000 were treated for ESRD in that year, and an occurs among men aged 25 to 44 years, with African additional 114,000 persons were living with functional American males facing 20 times the risk of kidney transplanted kidneys. ESRD, however, killed almost failure as their white counterparts. In addition, 80,000 persons in 2000, as many Americans as breast American Indians are almost three times as likely to and prostate cancer combined. develop ESRD as whites, and Asians are 1.6 times as continued on page 2 U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion
  2. 2. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt continued from page 1 likely. Persons of Mexican descent also appear to be at elevated risk for ESRD. Spotlight Given the high rate of undiagnosed chronic kidney Prevention Opportunities disease (CKD) in the United States, increasing Because the two major causes of kidney damage— awareness ranks among the most powerful tools to diabetes and high blood pressure—can generally be keep kidney disease from progressing to ESRD. The controlled, there are great opportunities to prevent National Kidney Disease Education Program, an CKD and keep it from progressing to ESRD. The key initiative of the National Institutes of Health (NIH), to prevention is early diagnosis and prompt treatment aims to reduce suffering and death from kidney disease before damage becomes extensive. Early CKD, through a major public information campaign called however, can only be detected by laboratory tests that “You Have the Power To Prevent Kidney Disease.” need to be part of routine medical care, especially The effort aims to inform high-risk populations, the for persons with known risk factors. At present, healthcare professionals who provide their primary however, CKD receives inadequate recognition and care, and policymakers and health coverage providers treatment. In many medical practices, fewer than one- about the vital need for widespread kidney disease tenth of Medicare patients known to have diabetes screening and the prompt use of the most effective receive kidney screening. And many CKD patients, treatments. In collaboration with more than 30 particularly African American men, do not receive partners—including medical specialty societies, referrals to kidney specialists, known as nephrologists, government agencies, patient advocacy groups, until late in their disease. and service organizations—the National Institute of Diabetes and Digestive and Kidney Diseases, an Diabetes causes the blood to collect excessive amounts element of NIH, began work on the program in 2000. of a sugar called glucose, which, over time, damages continued on page 3 the tiny blood vessels involved in the kidneyʼs filtering action. CKD has no known cure, but a 10-year study has shown that keeping diabeticsʼ glucose levels close Key Facts About Chronic Kidney to normal through a regimen of diet, exercise, and Disease medication cuts by one-half the development and progression of early CKD; the regimen is known as • An estimated 8 million Americans have CKD, but intensive management. Other studies confirm the many do not know it. benefit of tight glucose control. • CKD can lead to kidney failure (also known as end-stage renal disease or ESRD), which causes Excessive blood pressure also damages blood vessels, death unless the person receives dialysis or a including those in the kidneys, and is especially kidney transplant. harmful when combined with diabetes. To control • CKD raises the risk of cardiovascular disease. blood pressure and prevent kidney damage, individuals should maintain a normal weight, eat a diet low in • CKD can occur at any age and affects both males sodium and fat, and limit consumption of alcohol and females. and caffeine. Medications known as angiotensin- • Testing can detect CKD in its early stages. converting enzyme (ACE) inhibitors and angiotensin- • African Americans face almost four times the CKD receptor blockers (ARBs) also help control blood risk of whites. pressure. The medications slow the loss of kidney function in persons who do not have diabetes and help • Diabetes and high blood pressure together to protect the kidneys in people who do. At present, account for 70 percent of CKD. however, only one-third of people diagnosed with • Controlling diabetes and blood pressure can CKD receive ACE inhibitors. prevent or slow CKD. U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion 2
  3. 3. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt continued from page 2 The first target population is the one at highest risk— African Americans with diabetes, high blood pressure, Resources and a family history of kidney disease—along with The National Institute of Diabetes and Digestive their primary healthcare and health coverage providers. and Kidney Diseases, the nationʼs leading kidney Over time, the campaign will be expanded to other research agency, provides information on the kidneys high-risk ethnic and racial groups and will make and kidney disease through the National Kidney special efforts to reach persons with low incomes and Urologic Diseases Information Clearinghouse and other challenges such as illiteracy and impaired (NKUDIC) at http://kidney.niddk.nih.gov/about/. hearing and vision. NKUDIC answers questions about kidney disease and provides free publications, referrals to healthcare Clear, science-based messages tailored to each providers, and information about organizations that aid audience will be spread through brochures, posters, kidney patients and their families. Free, personalized Web sites, public service announcements, and even service is available by phone between 8:30 a.m. and hand-held fans bearing kidney health slogans. An 5 p.m. eastern time, Monday through Friday, at 1-800- optimistic, upbeat tone will emphasize each informed 891-5390 or 301-654-4415, by fax at 301-907-8906, individualʼs potential impact on kidney disease. by e-mail at nkudic@info.niddk.nih.gov, or by regular mail at NKUDIC, 3 Information Way, Bethesda, MD Between April 2003 and April 2004, pilot projects 20892-3580. tested the elements of the campaign in Atlanta, Georgia; Baltimore, Maryland; Cleveland, Ohio; and Other groups serving kidney patients include the Jackson, Mississippi. In each city, local coalitions following: organized, carried out, and evaluated an array of approaches to raising kidney disease awareness. “You American Association of Kidney Patients, a Have the Power To Prevent Kidney Disease” is slated membership organization, has chapters in various to go national in summer 2004. cities, an annual convention offering educational sessions, and print and online publications covering treatment options, news from Washington, DC, of Survey Finds Low Public Awareness interest to kidney patients, and more at www.aakp.org. of Kidney Disease Risk American Kidney Fund (www.akfinc.org/) provides direct Many persons at high risk greatly underestimate financial assistance to kidney patients in need as well as their chances of developing CKD, according providing resources to educational programs, community to a 2004 survey. Only 15 percent of African service programs, and support for clinical research. Americans, for example, believed their risk to be higher than that of the general population. Childrenʼs Kidney Disease Support Group (www. Only 13 percent of respondents knew that the childrenskidneydisease.org) provides resources for early stages of CKD cause no symptoms. “Such parents of children with kidney disease, including misunderstandings are dangerous,” said Janice online support group meetings. Lea, M.D., of the National Kidney Disease Education Program Coalition. “People find Kidney and Urology Foundation of America (www. themselves in the emergency room, on dialysis, kidneyurology.org/homepage.htm), a nonprofit before they even know they have a problem. organization, provides information and services for That’s why it is so important to . . . have your patients, including referrals to healthcare providers, blood and urine regularly tested for kidney emergency grants, and various scholarship and awards disease once you know you are at risk.” to assist kidney patients in completing their education and attaining other goals. continued on page 4 U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion 3
  4. 4. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt continued from page 3 Life Options at www.lifeoptions.org is a nonprofit The NephCure Foundation will honor 50 kidney organization providing a variety of resources to inform donors during the Elpis Awards on Saturday, October and support kidney patients, their families, and friends; 30, 2004, at the Independence Seaport Museum at these resources include an online community and Pennʼs Landing in Philadelphia. This Academy Kidney School, an interactive educational program Awards-style event will pay tribute to these donors online at www.kidneyschool.org. for the hope they have provided to kidney patients seeking a healthy life. Elpis is the Greek word for The National Kidney Foundation (www.kidney.org) hope. The National Institute of Diabetes and Digestive provides a wide range of information for kidney and Kidney Diseases (NIDDK) will match 100 percent patients and their families, as well as several electronic of the funds raised. Call 610-540-0186, ext. 23, or message boards discussing kidney disease. visit www.nephcure.org/Events_elpisawards1.htm to nominate a donor or for more information. The Renal Support Network (www.renalnetwork.org) provides many resources for dealing with medical and NIDDKʼs National Kidney Disease Education Program nonmedical aspects of kidney disease, including the has developed the “You Have the Power To Prevent Find-a-Friend program, which places families affected Kidney Disease” campaign. Because blacks are four by kidney disease in touch with one another. times more likely to develop kidney failure than whites, the campaign focuses on black adults who RenalNet (www.renalnet.org/renalnet/renalnet. are at risk and on primary care providers who play cfm) provides a wide range of Internet-accessible an important role in detecting and managing kidney information resources about kidney disease, including disease. To check out radio and print public service chat rooms covering various renal healthcare topics. announcements—as well as other pertinent facts, statistics, and survey findings—visit www.nkdep.nih. gov/news/nationalcampaign/index.htm. Activities An estimated 20 million people have chronic kidney The Kidney Cars Program offers an easy way to disease, and another 20 million are at risk. The donate your car, van, truck, or boat. Proceeds National Kidney Foundation offers a way to help from Kidney Cars are used in the communities in reduce these rates by sponsoring the Kidney Walk. which they are raised to fund a variety of National This event presents an occasion for dialysis patients, Kidney Foundation organ donation programs, public organ transplant recipients, donor families, medical education, patient and community services, research, communities, and the general public to celebrate and professional education. For more information and life. The Kidney Walk is a noncompetitive walk stories from actual Kidney Cars donors, visit www. focusing on education and the prevention of kidney kidney.org/funds/kidneycars/index.cfm. and urinary tract diseases as well as awareness of the need for organ donation. For registration and location The American Kidney Fundʼs (AKFʼs) Calendar information, visit www.kidney.org/funds/kidneywalk/ Contest is an opportunity for pediatric kidney patients index.cfm. younger than age 18 to showcase their drawings in AKFʼs annual “Kid”ney Calendar, which is sent The second annual Seattle 100—Racing Towards to donors in appreciation of their support. The 13 a Cure for Kidney Disease will take place on winning artists and their parents are rewarded with September 8, 2004. The event will raise money to a fun-filled visit to Washington, DC. Click on www. further the NephCure Foundation mission to support akfinc.org/Programs/ProgramsContentCalendar.htm to research seeking the cause of nephrotic syndrome and enter the contest or to order one of these imaginative FSGS (focal segmental glomerulosclerosis), two types “Kid”ney calendars. of kidney disease that can lead to the need for a kidney continued on page 5 U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion 4
  5. 5. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt continued from page 4 transplant. The Seattle 100 is not a motorcycle race care of nondialyzed patients with chronic kidney but a road course endurance event for charity. For failure. However, the clinical usefulness of dietary more information (or to plan a fundraiser like this modification is still controversial. New research one in your area), visit www.nephcure.org/Events_ supports the view that high-protein diets accelerate secondseattle100.html. renal disease progression and that different protein sources have different consequences. In the Literature Physical and Sexual Function in Women With The Importance of Family History on the Chronic Kidney Disease. Kurella, M., et al. Development of Renal Disease. Satko, S.G., and American Journal of Kidney Disease 43(5) (May Freedman, B.I. Current Opinion in Nephrology and 2004): 868–876. Hypertension 13(3) (May 2004): 337–341. In a large cohort of women enrolled in the Heart and Family members of individuals with chronic kidney Estrogen/Progestin Replacement Study, the authors disease are disproportionately affected by unrecognized studied possible associations between chronic kidney nephropathy (a disease or abnormality of the kidney). disease (CKD), physical function, and sexual function. This observation has led to the search for a genetic They found that CKD is associated with impaired component of this susceptibility. Screening of these physical function and that a decline in estimated high-risk relatives will probably lead to successful glomerular filtration rate is associated with a decline in treatment of nephropathy and slow the growing physical function but not with the psychosocial aspects worldwide epidemic of end-stage renal disease. of sexual function. Morbid Obesity Is Not a Contraindication to Willingness of Patients To Switch From Kidney Transplantation. Marks, W.H., et al. Conventional to Daily Hemodialysis: Looking American Journal of Surgery 187(5) (May 2004): Before We Leap. Halpern, S.D., et al. American 635–638. Journal of Medicine 116(9) (May 2004): 606–612. Historically, concern that morbidly obese kidney Although daily dialysis (six 2- to 3-hour in-center transplant recipients have worse outcomes than treatments per week) has received widespread support nonmorbidly obese recipients has led many transplant from funding agencies, lawmakers, and nephrologists, centers to deny transplantation to the former group. 44 percent of the 126 patients interviewed in this study However, these researchers have found that morbidly would not choose daily dialysis regardless of its health obese persons have 3-year graft and patient survivals benefits. The remaining 56 percent indicated that they similar to those of nonobese persons. Although the would consider switching if daily hemodialysis was obese patients have more serious complications and shown to yield certain health benefits. spend more days in the hospital, the authors believe that these reasons are not sufficient to deny this The Role of Physician Assistants in Improving population the advantages of kidney transplantation. Renal Care. Smith, G.O., Jr. Nephrology News & Issues 18(5) (April 2004): 51–56. New Insights Into Protein Intake and Progression There is currently only a small group of nephrology of Renal Disease. Lentine, K., and Wrone, E.M. physician assistants (PAs); recruiting and training more Current Opinion in Nephrology and Hypertension PAs in the field is an absolute necessity. The number 13(3) (May 2004): 333–336. of individuals with kidney disease in the United States For several decades, restricting protein in the diet is increasing at a rate that outpaces our ability to has been accepted as a strategy to slow renal disease develop and train nephrologists. Well-trained PAs can progression. Recently, a National Kidney Foundation provide closer monitoring of patients and help prevent advisory board incorporated recommendations for potential major problems in the outpatient arena. supervised low-protein diets into guidelines for the U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion 5
  6. 6. Volume 18: Issue 4 Summer 2004 http://odphp.osophs.dhhs.gov/pubs/prevrpt Meetings 37th Annual Meeting and Scientific Exposition of the American Society of Nephrology. St. Louis, MO. 13th Congress of the International Pediatric Visit www.asn-online.org/education_and_meetings/ Nephrology Association. Adelaide, Australia. Renal%20Week/renal_week.aspx. October 29– Visit www.hartleymgt.com.au/ipna. August 29– November 1, 2004. September 2, 2004. 58th Annual Fall Conference and Scientific Sessions 31st Annual Convention of the American of the Council for High Blood Pressure Research Association of Kidney Patients. Bal Harbour, in Association With the Council on the Kidney in FL. Visit www.aakp.org/AAKP/convention.htm. Cardiovascular Disease. Chicago, IL. Visit www. September 2–5, 2004. americanheart.org/presenter.jhtml?identifier= 3015752. October 9–12, 2004. National Renal Administrators Associationʼs Annual Conference: Inaugural National Patient Meeting. Denver, CO. Visit www.ikidney.com/ iKidney/Calendar/2004/September/30/HealthHappiness Hope.htm. September 30–October 2, 2004. U.S. Department of Health and Human Services • Office of Disease Prevention and Health Promotion 6